Dawaa Reference

acute

Dysthymia (Persistent Depressive Disorder)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Escitalopram 10 mg film-coated tablets SmPC section 4.2 Posology and method of administration (eMC product 7069) · Fluoxetine 20 mg Capsules SmPC section 4.2 Posology and method of administration (eMC product 11909) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Patel RK, Aslam SP, Rose GM. Persistent Depressive Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK541052.

Verified against4 documents
  • LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)
  • SmPC section 4.2, https://www.medicines.org.uk/emc/product/11909/smpc
  • SmPC section 4.2, https://www.medicines.org.uk/emc/product/7069/smpc
  • Patel RK, Aslam SP, Rose GM. Persistent Depressive Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK541052.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (12)

  • Low mood for most of the day, on more days than not, lasting two years or longer [low mood]
  • Appetite is off: either poor or excessive
  • Sleep is disturbed: either too little or too much
  • Low energy or persistent tiredness [fatigue]
  • Poor opinion of oneself
  • Trouble concentrating, or difficulty reaching a decision [poor concentration]
  • A settled sense of hopelessness [low mood]
  • At least two of those six accompany the low mood [low mood]
  • Never free of the symptoms for more than two months at a stretch, and one year is enough in a child
  • There must never have been a manic or hypomanic episode
  • The symptoms have to be causing real distress or damage at home, at work or socially
  • It is easily missed, and the suicide risk is higher than average

Signs — what you find (10)

  • Appearance may be unkempt, reflecting neglected self-care
  • Slowed movement, and behaviour ranging from cooperative to withdrawn [social withdrawal]
  • Note the rate and tone of speech
  • Mood is described as depressed or sad, and the affect can be narrowed
  • Check thought content for hallucinations and delusions, and whether thinking is clear and coherent [delusions · hallucinations]
  • Ask directly about suicidal thoughts and plans, access to weapons, self-injury and aggressive thoughts [suicidal thoughts]
  • Test orientation to person, place and date
  • Insight ranges from partial to absent, and judgement can be impaired enough to affect decisions
  • Blood pressure and pulse matter, since they point to physical illness underneath
  • Examine the nervous system, heart and lungs, and the skin for signs of drug use or infection

Tests (12)

  • No blood test or scan diagnoses it
  • Information from family or close contacts helps
  • Routine bloods add little in an otherwise healthy person, but are commonly sent to support decisions
  • Those usually are blood count, metabolic panel, pregnancy and toxicology urine tests
  • Plus HIV, a syphilis test, vitamin B12, folate and thyroid function
  • Ask about tobacco, alcohol, cannabis and other substances
  • Look for Parkinson disease, multiple sclerosis, syphilis or HIV behind the mood
  • Also brain lesions, heavy metal poisoning, delirium, and metabolic or hormonal disease
  • Trace the timeline of symptoms and what set them off and keeps them going
  • Ask whether acute depressive episodes come before or after stretches of low-grade depression
  • Drawing a life chart or timeline can bring the pattern of depressive symptoms into view
  • Conduct the physical examination with care where there is a history of trauma

If not this — what else fits (8)

  • Major depressive disorder, which should be diagnosed alongside if its criteria are also met
  • Depressive symptoms lasting over two years that fit neither this nor major depression
  • Any past manic or hypomanic episode rules it out and points to bipolar disorder
  • Cyclothymia, where hypomanic symptoms fall short of an episode alongside two years of low mood
  • A psychotic disorder, when the depressive symptoms occur only within it
  • Mood disorder caused by another illness, multiple sclerosis for instance
  • Mood disorder caused by a drug of abuse, a prescribed medicine or a toxin
  • Personality disorder, which frequently coexists, in which case both are diagnosed

SourceStatPearls "Persistent Depressive Disorder" - disease-level clinical article

Presentation findings are traced to the source above.

1

SERTRALINE

1st line

Strength50 mg

Formoral.solid

Adult dose and duration

50 mg once daily, titrate up to max 200 mg daily if required - Long-term

Paediatric dose

Should not be used in the treatment of children and adolescents under the age of 18 years, except for patients with obsessive compulsive disorder aged 6-17 years old.

Dose source

LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)

Why

Standard SSRI starting dose, equally applicable to the chronic low-grade depression of dysthymia as to anxiety or major depression.

Cautions
  • Onset of benefit takes 2-4 weeks; warn the patient in advance so they do not stop early.
  • Monitor for worsening mood or suicidal ideation in the first 2-4 weeks, especially under age 25.
  • Do not combine with MAO inhibitors; taper rather than stop abruptly.
  • Refer to psychiatry if there is no response, risk features develop, or a superimposed major depressive episode ('double depression') occurs.
  • RED FLAG - Suicidal ideation or self-harm risk, or psychotic features: refer to psychiatry urgently.
Egyptian brands
Egyptian brandManufacturerIndicative price
OPIRALINE 50 MG 20 F.C. TABS.EL-OBOUR29.00 EGP (1.45/unit)
AGRELOCIT 50 MG 20 TAB.MEMPHIS > ATM PHARMACEUTICAL INDUSTRIES34.80 EGP (1.74/unit)
DEPR-STAT 50MG 10 CAPS.MEMPHIS21.60 EGP (2.16/unit)
SESERINE 50MG 30 TAB.ADWIA75.00 EGP (2.50/unit)
SERPASS 50MG 30 F.C.TAB.GLOBAL NAPI PHARMACEUTICALS102.00 EGP (3.40/unit)
SIRTO 50MG 10 F.C. TABS.HI-PHARM34.00 EGP (3.40/unit)
MOODAPEX 50 MG 30 F.C.TAB.MULTI-APEX111.00 EGP (3.70/unit)
LUSTRAL 50 MG 20 F.C.TABS.VIATRIS136.00 EGP (6.80/unit)
2

ESCITALOPRAM

2nd line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg PO once daily, may increase to max 20 mg once daily. - Long-term (continue 6-12 months)

Paediatric dose

Contraindicated / not recommended in children and adolescents under 18 years.

Dose source

SmPC section 4.2, https://www.medicines.org.uk/emc/product/7069/smpc

Why

Same standard SSRI starting dose used across the depressive/anxiety spectrum, appropriate for persistent depressive disorder.

Cautions
  • Alternative first-line SSRI if sertraline is not tolerated or preferred.
  • Onset of benefit takes 2-4 weeks.
  • Escitalopram is contraindicated in patients with known QT interval prolongation or congenital long QT syndrome, and together with medicinal products that are known to prolong the QT interval.
Egyptian brands
Egyptian brandManufacturerIndicative price
ESCTIKANA 10 MG 14 F.C.TABS.HOCHSTER PHARMACEUTICAL INDUSTRIES17.00 EGP (1.21/unit)
CITALOMEP 10 MG 14 F.C.TABS.MEPACO26.00 EGP (1.86/unit)
ECANOPRAM 10 MG 14 F.C. TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > EGYPTIAN CANADIAN FOR DRUG30.00 EGP (2.14/unit)
MOODAMASH 10 MG 14 F.C. TABS.MASH PREMIERE63.00 EGP (4.50/unit)
EXCELSA 10 MG 14 F.C.TABS.PHAROPHARMA66.00 EGP (4.71/unit)
ESCITA 10 MG 14 F.C.TABS.GENESIS PHARMACEUTICALS77.00 EGP (5.50/unit)
CIPRAPRO 10 MG 30 F.C.TABS.MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) > COPAD PHARMA237.00 EGP (7.90/unit)
CIPRALEX 10 MG 28 F.C.TABS.LUNDBECK > MULTIPHARMA392.00 EGP (14.00/unit)
XYGAROT 5MG/5ML SYRUP 100ML? strength differs? different route - not oral solidMULTI-APEX21.00 EGP
ESCITALOBORG 5 MG/5ML SYRUP 125 ML? strength differs? different route - not oral solidBORG50.00 EGP
3

FLUOXETINE

3rd line

Strength20 mg

Formoral.solid

Adult dose and duration

20 mg PO once daily. - Long-term (continue 6 months post-remission)

Paediatric dose

(Age 8-17y (specialist supervised): start 10 mg (2.5 ml oral solution) once daily, may increase after 1-2 weeks to 20 mg once daily.)

Dose by age
8 to under 18 years:Specialist supervised: start 10 mg (2.5 mL oral solution) once daily; may increase after 1 to 2 weeks to 20 mg once daily.
Dose source

SmPC section 4.2, https://www.medicines.org.uk/emc/product/11909/smpc

Why

The same SSRI dose used for major depressive disorder is appropriate for the chronic low-grade depression of dysthymia.

Cautions
  • Alternative SSRI, useful if the patient has fatigue or low energy given its more activating profile.
  • Monitor closely for suicidal ideation in young adults during initial weeks.
  • Do not combine with MAO inhibitors or other serotonergic drugs.
Egyptian brands
Egyptian brandManufacturerIndicative price
FLOROSIN 20MG 10 CAPS.UP PHARMA11.00 EGP (1.10/unit)
PHILOZAC 20MG 10 CAPS.AMOUN11.00 EGP (1.10/unit)
FLUOXETINE 20 MG 10 CAPS.MISR18.60 EGP (1.86/unit)
ELEVAMOOD 20 MG 28 CAPS.UNIPHARMA56.00 EGP (2.00/unit)
OCTOZAC 20MG 10 CAPS.OCTOBER PHARMA21.60 EGP (2.16/unit)
PHILOZAC 20MG 30 CAPS.AMOUN75.00 EGP (2.50/unit)
PROZAC 20MG 14 CAPS.ELI LILLY118.00 EGP (8.43/unit)
FLUOXETINE 20 MG H.G.CAPS.SIGMA8.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.